Long Term complications

I had RNY in 2005 over 11 years ago now.  I have gone through Internal Hernia, 2 bowel obstructions, 1 ruptured ulcer, Gallbladder issues requiring removal, hypoglycemia, and vitamin deficiencies.  Now with pain in my limb, doctor has diagnosed it as more ulcers in the limb as well as one in the pouch (this one is healing with meds), but the limb ulcers are not responding to meds.  The suggestion is for removal of limb and reconnection of the pouch connection to a lower part of the intestine.  I really trust this doctor as he has quite literally saved my live 2 times as well as removed my gallbladder.  But even though we have discussed this, is there anything I should be considering that I am not aware of that someone who has had this done may have insight into?  I know that I can not continue to live in pain and fear of pain when eating (the belief is that the limb is over producing acid in reaction to what I am actually eating).

I think they need to find out why you are having the ulcers. What is causing them. Because even if the reconnect - new ulcers may start showing up unless they can find out what is causing it. 

sometimes ulcers can form due to inflammation - food allergies, bacterial overgrowth, and overall imbalances - vitamins and minerals... 

I was diagnosed with food allergies and bacteria in my guts... it is not easy - but it really helps when I avid foods that I am allergic to... 

I was recently hospitalized with a narrowing of my small intestine at a spot close to the anastamosis (where the bypass connection is), and I talked with two surgeons about what would have to be done (how much would have to be removed, and from which locations) if the condition did not resolve on its own, so the two things that come to my mind are

1) I am confused, because the small intestine does not produce acid; the stomach does. The intestine actually produces bicarbonate (an antacid). I can understand wanting to remove the portion of the intestine that has an ulcer, but I don't think that is going to address the root problem. If the surgeon removes part of the roux limb and then you end up with new ulcers, where do you go from there?  If it is going to put you right back where you are, but having even less intestine, I would think it would be better to be sure about what is causing the problem and be sure that is addressed.

2) How much intestine is he proposing to remove? (They have to remove both part of the roux limb and part of the other section of intestine because they have to eliminate the original anastamosis and the new one cannot be too close to the old one (I guess if it is, there can be complications).)  If a significant amount of either section is removed, you will lose even more of your ability to absorb nutrients which could cause problems down the line. It would likely mean increasing your vitamins doses (which isn't a big deal) but it might also mean that you need to significantly increase your protein intake in order to get enough, and it may be difficult to get enough protein without overeating.

Also, if he believes that what you are eating is causing the excess acid, wouldn't changing your diet help combat that?  Has he tried multiple medications to try to get the intestinal ulcers to heal?  (Unfortunately, sometimes some surgeons are a little too quick to want to cut...)

I'm sorry you are having so much trouble.  I hope you can get it resolved soon.

Lora

Insight offered might be for you to seek a second opinion.  Your trusted doctor sounds like he would welcome it to either get ideas or confirm the remedy planned.  You have been through a lot and are smart to proceed with caution.  

I also suggest a second opinion from a good revision surgeon. I have had my share of post op complications over the years. A surgeon specializing in revisions is better than someone guessing what they think it may be. Sounds like a gastric fistula with a blind limb.  Both need to be surgically fixed